PHE ScreeningNews and updates from the Public Health England screening programmes2019-01-21T15:04:28Zhttps://phescreening.blog.gov.uk/feed/Lisa Summershttps://phescreening.blog.gov.uk/?p=176892019-01-21T15:04:28Z2019-01-21T09:28:57ZI am pleased to announce the appointment of 2 new clinical leads for the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme: National Surgical Lead Akhtar Nasim and National Imaging Lead Tim Hartshorne.

Their appointments follow the retirement of Jonothan Earnshaw, who oversaw the implementation of the national programme as its first clinical lead from 2009.

Akhtar graduated from Aberdeen University in 1990 and trained as a vascular surgeon in Leicester. As a trainee surgeon, he was one of the pioneers of endovascular aneurysm repair (EVAR) in the UK and helped set up the EVAR programme in Leicester. He was appointed as a consultant vascular surgeon in 2001, working at South Manchester University Hospitals Trust before moving back to Leicester in 2005.

He has extensive surgical experience of both open and EVAR surgery and has published extensively on AAA repair in peer reviewed journals. His other interest is in undergraduate education and he has contributed significantly to the Leicester Medical School. In recognition of this he was awarded Associate Professorship in Medical Education by University of Leicester in 2016.

Akhtar helped set up the AAA screening programme in Leicestershire, which was one of the early implementer sites in England in 2009. His leadership roles have included being the head of service in the Leicester Vascular Unit from 2013 to 2016 and chair of the East Midlands Vascular Advisory Group since 2016.

He said:

I am very pleased to be joining the national team. There are exciting challenges ahead with regard to programme optimisation, tackling inequalities, and developing strategies to better address the cardiovascular disease risk factors in men under surveillance.

Tim works as Chief Clinical Vascular Scientist at University Hospitals, Leicester. He has more than 30 years’ experience working in vascular ultrasound and has published a leading text book on the subject.

He has been heavily involved with the local Leicestershire AAA programme where he has been the quality assurance and clinical skills trainer lead. He has also provided expert ultrasound advice to the national programme since its roll-out.

Tim published research into the reliability of the inner-to-inner wall method of aortic diameter measurement that is used by the screening programme and endorsed by the National Institute for Health and Clinical Excellence (NICE).

In his new role, one of the many things he will be focusing on is the assessment and measurement of ultrasound image quality.

He said:

I am delighted to be continuing my association with the national team in this new role. It is a real pleasure working with the team. Among a number of exciting projects, I am particularly looking forward to reviewing and updating guidance on the assessment of ultrasound image quality. I am also looking forward to meeting more local screening teams in this new position.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

]]>1Professor Anne Mackiehttps://phescreening.blog.gov.uk/?p=175102019-01-11T09:35:24Z2019-01-11T09:34:06ZPublic Health England (PHE), the UK National Screening Committee (UK NSC) and the NHS Screening Programmes are recognised internationally as models of good practice.

It is therefore vital that all of us in the public health community do not accidentally damage that reputation when acting with the best intentions.

It is particularly important for colleagues working in PHE and NHS England to understand population screening and the rigorous criteria and processes that underpin our national programmes. Any initiatives to do something about common risk factors or disease must not undermine or overlap with population screening. That could result in contradictory policies, damaged reputation and a lot of work to undo the damage.

There must be evidence that benefits clearly outweigh harms for the population as a whole to justify screening

For example, we know many NHS colleagues will be as concerned as us about the effects of Group B Streptococcus in newborn babies. So some hospitals may be keen to offer testing to pregnant women. But if such testing is offered to all women regardless of risk factors or previous clinical history, this becomes population screening and is therefore for the UK NSC to make a recommendation on.

The UK NSC last did this in March 2017 and recommended against screening. Local initiatives, outside of carefully planned and evaluated pilot schemes, can be a ‘back door’ to screening, without the national standards, training, data collection and quality assurance that the UK NSC-recommended programmes have.

It may also seem obvious to add a test for atrial fibrillation to routine contacts with middle aged and older adults because early treatment can lead to better health outcomes. Unfortunately, screening is indiscriminate and picks up all sorts of other problems, such as unknown heart rhythms, that would never make the person ill. Once discovered they can set an individual off on a journey from being a well person to being sick, which means more tests, more worry, pills and treatments which they never needed.

It is because so many well people are involved that there is international agreement that the benefits of helping a person with early disease must be balanced against the certainty of harming and frightening thousands of well people. Ideally, this balance should be studied through proper randomised population screening trials. Screening must be based on high quality evidence of its overall benefit to the population. It must not be introduced based on the anecdotal opinions of individual clinicans, managers and policy makers. Additionally, introducing new tests can also divert huge amounts of money from diagnosis and care to testing millions of well people and taking money from interventions such as smoking cessation, or exercise on prescription.

So, if you are thinking of testing or applying a questionnaire to a whole population – such as all pregnant women, all newborn children or all individuals within a certain age range – then please exercise caution. Stop and speak to the PHE Screening team first.

Why screening is different

NHS screening programmes are based on internationally recognised criteria and a rigorous evidence review process. Our 11 national programmes each year enable millions of people to make informed decisions about their health, helping thousands to live longer lives.

Screening policy has a particular place in the NHS Constitution and screening programmes differ from other national programmes, campaigns or advice to people to adopt or change behaviours. Unlike screening, campaigns such as One You and Stoptober do not write to people in their homes offering an appointment for a test or treatment.

Clinical guidance, such as those for atrial fibrillation in people on hypertension registers, provides tests and treatment to people who know they are at risk or are currently unwell. They are also done in the context of a face-to-face clinical discussion and are the responsibility of the National Institute for Health and Care Excellence (NICE) and the Royal Colleges.

In contrast, screening programmes write and offer tests to well people in their own homes on NHS-headed paper, and sometimes with their own GP’s name. PHE provides expertise on all aspects of health screening, advising the government and NHS so England has safe, high quality screening programmes that reflect the best available evidence and the UK NSC recommendations.

Screening is not perfect and is only recommended if strict criteria are met so that it does more good than harm at a population level. It is therefore important that population screening is implemented consistently throughout England. Small problems and variations in implementation can have a large impact and unintended consequences.

So, if you are thinking about implementing a health initiative, please consider its possible impact on screening. If any doubt, talk to the PHE Screening team first. We’re always here to help. And if you have suggestions for new types of screening, you can submit these to the UK NSC.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

The KPIs are used to measure how the 11 NHS screening programmes are performing and give a high level overview of their quality. They contribute to the quality assurance of screening programmes but are not, in themselves, enough to quality assure or performance manage screening services.

KPIs have 2 performance thresholds. The achievable threshold is the level at which the screening service is likely to be running optimally. The acceptable threshold is the lowest level which a screening service is expected to attain. KPIs are defined as small number KPIs if the number of individuals counted by the measure is less than 5.

We have picked out the main highlights of the data below, but would encourage you to look through the full datasets for more information on methodology, caveats and completeness of data.

Antenatal KPIs

All the published antenatal KPIs saw a continued improvement between 1 April 2017 and 31 March 2018 compared to the previous 2 years.

1 ID1 and ST3 thresholds changed in 2016 to 2017: acceptable from 90.0% to 95.0% and achievable from 95.0% to 99.0%.

2 ID3 and ID4 were introduced in 2017 to 2018. During the first year of these KPIs the data was collected but not published.

3 FA2 was introduced in 2016 to 2017. During the first year of this KPI the data was collected but not published.

4 We do not recommend that ST2 is used to compare performance between maternity services as there are inconsistencies in the way it is reported.

Newborn KPIs

Improvements were seen in all newborn KPIs in 2017 to 2018 except for the timely assessment for referrals KPI in the newborn hearing screening programme (NH2), which saw a slight decrease in performance.

The newborn blood spot KPI for avoidable repeat tests (NB2) also saw continued improvement with national performance down to 2.5% (NB2 is a reverse polarity KPI where a lower figure is better).

Young person and adult KPIs

Across the abdominal aortic aneurysm (AAA) KPIs, performance of the 3 KPIs remained above the acceptable and below the achievable thresholds.

It is the first year of data publication for the 6 new KPIs for the cancer screening programmes. National performance was above the acceptable thresholds for bowel uptake (BCS1), breast uptake (BS1), and breast screening round length (BS2), but below for cervical coverage (CS1 and CS2).

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

Many radiographers are not currently working in their profession having left for a variety of reasons, including raising a family or trying a different career. But these qualified mammographers have the skills and experience to make a big difference to the breast screening service.

PHE is supporting the national HEE campaign, which runs until the end of March 2019.

How breast screening units can help

Provide clinical placements for returning mammographers

These skilled professionals do not need to re-train. All they need to do is update their skills in a clinical setting to meet the Health and Care Professions Council (HCPC) RtP registration requirements and get back into work. The Society of Radiographers website also has information on how units can support a radiographer who wants to return to work in the breast screening programme.

Run a local campaign

Breast screening centres are using available resources to run local campaigns to promote mammography return to practice.

Why not use the campaign case study to continue to raise awareness of the RtP campaign over the next few months? The case study about Philippa Martin is great because she's such a good example of someone who has returned to practice. It can be printed or used digitally as part of your local campaign.

Another option is to run a social media campaign using the materials #iamreadytoreturn provided by HEE.

Apply for funding

Any breast screening centre providing a clinical placement can claim a one off £500 placement fee for each returnee they support. Further details are available through from HEE.

Benefits are huge

There are huge benefits to encouraging trained mammographers to RtP. It is a quick way to fill posts, use less agency workers and raise the profile of your organisation as an employer of choice.

Further information is available on the HEE website for both returners and organisations offering a clinical placement.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

GOV.UK

Blog

If you are interested in the latest cervical screening news, you should bookmark the PHE Screening blog at the relevant category. You can also subscribe to the PHE Screening blog to get regular emails about all population screening programmes.

Archived information

For any archive documentation from the extranet please contact the screening team via the screening helpdesk.

Information for the public

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

Public Health England Screening is encouraging doctors to apply for a new training programme in breast disease management and help boost the screening workforce.

The new 3 year credential programme will create breast clinicians trained in breast imaging, clinical examination and genetic risk, allowing them to lead screening services, family history clinics and work in symptomatic clinics. Many will also undertake surgical procedures such as biopsies.

Trainees will be recruited either directly after they have qualified or from other backgrounds and training pathways, such as general practice.

The new programme will start in August 2019 and there are 10 places available in England. For a more detailed description of training requirements, the person specification and terms and conditions, please contact the Royal College of Radiologists (RCR). It will initially be run as a pilot and hosted by 5 English breast screening centres with links to radiology training programmes.

Health Education England (HEE) has agreed to provide funding of up to £30,000 per trainee per year to support employment and training.

Training centres sought

Expressions of interest are being sought from centres to part fund and provide training, support and assessment for this exciting new project.

Manchester’s new national breast imaging academy is supporting the programme and one of the centres is likely to be in the North West – leaving opportunities for 4 more. Interested centres should contact either the Association of Breast Clinicians (ABC) or the RCR to discuss in more detail.

This training programme has been developed by the RCR, ABC and HEE in line with General Medical Council guidance. It will be fully evaluated in due course.

I'd urge training centres to consider taking part in the expert training programme. The breast screening service in England needs you to help us tackle workforce issues.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

]]>0Nick Johnstone-Waddellhttps://phescreening.blog.gov.uk/?p=172512019-01-04T09:29:19Z2019-01-04T09:29:19ZTalking to someone the other day from a local screening provider who wasn't aware of how to order screening leaflets and hadn't heard of the blog or the helpdesk, I wondered how many other people haven't come across these resources and services.

Even for those of you who have, it can be hard to remember exactly where to go for all the information related to population screening in England.

So in an attempt to be helpful we've created a simple one-side A4 poster you can print out and stick above your computer or on the office notice board. It includes just 6 weblinks you need to know. Between them they'll keep you fully informed and in touch!

The links cover:

the screening blog (as you're reading this now, it's unlikely you haven't heard of it but you may have colleagues who haven't)

the helpdesk, run by the incredibly helpful and friendly Andrianna, Linda, Marcia and Katy

how to order screening leaflets

where to find information for professionals

accessing education and training resources

where to find information for the public

Let us know if there are any other links we could usefully add next time we update the poster.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

Our students join us in Warwick Medical School for a week, where they learn from experts and researchers from Public Health England (PHE) and the university. The aim is to help them identify important ethical issues associated with screening and give them a better understanding of the way in which decisions are made on which screening programmes to introduce. The module is taught as a 5 day intensive study block comprising of lectures, group work and supervision.

We looked at important screening issues such as test accuracy, overdiagnosis, research and bias, quality assurance, health economics, ethics and policy making. The course is designed to help those working in screening or public health to take a step back and think about the principles of screening.

The latest group of students engaged in lively debates during their week and finished off by making group presentations.

Great feedback

We always ask our students how they have found the course and the latest cohort told us they really valued the opportunity to meet other enthusiastic and engaged colleagues.

Many told us how the week had challenged their beliefs and been “thought provoking”. Students also commented on the “excellent teachers” who were “very knowledgeable about the subject matter”. In particular, they highlighted talks by Angela Raffle, joint author of the leading international textbook on screening, Sue Cohen, who spoke about quality assurance, and PHE's Director of Screening Professor Anne Mackie.

Final assignment

Our students are now busy working on a 4,000-word assignment due on Wednesday 6 February 2019. This is where they put into practice everything they've learned over the week. All the tutors are really looking forward to reading the assignments and welcoming our next group in November 2019.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

General information

Professor Anne Mackie, the Director of Programmes for the UK National Screening Committee, thanks everyone involved in the provision of screening in England for their hard work and expertise during 2018.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

I am sure you, like me, are looking forward to spending time with family and friends over Christmas at the end of a very busy and often challenging year in screening.

I’d like to take this opportunity to thank you all for your hard work and expertise over the past 12 months.

Learning from challenging times

Millions of people benefit from screening each year and we usually make the headlines for all the right reasons. As you know, that has not always been the case in 2018 because of issues with the arrangements for inviting women in the breast and cervical programmes.

We will carefully consider and learn from all the findings of the independent breast screening review report and emerge with an improved national programme as a result. At the same time, screening quality assurance service (SQAS) colleagues are working hard to support NHS England and Capita in investigating why thousands of women did not receive cervical screening invitation, reminder and result letters on time in 2017 and 2018.

I’d like to thank all of you in PHE Screening, as well as our commissioning and clinical colleagues, who have been working so hard to resolve and learn from these issues while continuing to provide exceptional screening services.

Tackling inequalities

During 2018, we screened well over 10 million individuals and identified hundreds of thousands who needed further investigation or essential treatment. Most of these people had not actively sought care and had no symptoms, which underlines why screening is such an important public health intervention.

We know some groups face barriers to accessing screening. Publication of our inequalities strategy in May underlined our commitment to do all we can to make sure screening is a truly equitable public health intervention regardless of location, ethnicity, age, disability or gender.

We have set up a new national operational group to drive this work forward and have already achieved a great deal, including:

All these resources give NHS screening providers powerful tools to help make sure people understand the screening they are offered and to participate if they wish to.

Evidence reviews

It has been another busy year for the UK National Screening Committee (UK NSC) and the national evidence team.

The UK NSC made 11 recommendations in 2018, including the decision to recommend lowering the age limit for bowel cancer screening. The committee decided against recommending screening for spinal muscular atrophy (SMA) but we are keeping a close eye on the development of a new drug that could provide more promising evidence for this next time around.

We are currently consulting on screening for 9 different conditions, including breast cancer and cervical cancer, and the evidence team has already started work on reviewing a further 27 conditions in 2019.

Preparing for major changes

We continue to support the NHS to change 4 of our most complex programmes with the introduction of:

Experts in genomics study the entire DNA content within one cell of an organism to help understand disease.

Genomic technology has the potential to transform healthcare by helping to:

determine disease risk

enhance preventive care

support more accurate diagnosis and inform therapeutic decisions

ensure more patients get the right treatment at the right time

We are working with the screening advisory committees to explore the potential to use genomic technologies in our existing programmes. Of particular interest will be how genomics might inform personalised screening and treatment strategies.

PHE screening is also providing advice and guidance on how screening principles might translate to whole genome sequencing (the process of determining the complete DNA sequence of an organism’s genome at a single time) in newborn infants.

Watch this space for developments as we continue to follow the evidence in 2019 and beyond.

Artificial intelligence in screening

Advances in artificial intelligence (AI) also have the potential to significantly impact the world of screening.

AI is the area of research that finds ways for computers to do things that typically require human expertise. This could include solving complex problems or learning from experience.

Recent years have seen great strides in machine learning, specifically in the field of computers being able to reliably identify disease in static images such as X-rays.

This raises the potential of AI in future being able to give a diagnosis based on an individual’s screening images – for example, mammograms in the breast screening programme and digital photographs in the diabetic eye programme.

We will monitor this new technology closely to make sure screening gets maximum benefits with minimum risk.

In line with the UK’s Industrial Strategy, which lists AI as one its 4 Grand Challenges, PHE Screening is developing a clear process for researchers, AI developers and service providers to follow. This will enable AI to be incorporated into screening safely, reliably and efficiently where appropriate.

See you in 2019

The PHE Screening blog is now taking a well-deserved rest over Christmas.

Have a wonderful break and see you all in 2019.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.